Learning About Hepatitis C/2010

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Learning About Hepatitis C/2010

INTRODUCTION

http://www.utdol.com/patients/content/topic.do?topicKey=~nVqO9/rmP3yrYlThe term "hepatitis" is used to describe a common form of liver injury. Hepatitis simply means "inflammation of the liver" (the suffix "itis" means inflammation, and "hepa" means liver). Hepatitis can be caused by a number of factors, including alcohol abuse, large doses of certain medicines, poisonous mushrooms, and viruses.Hepatitis C is caused by a virus that is spread from one person to another in blood and body fluids, such as by sharing IV drug needles or "works", or during pregnancy and delivery. Chronic hepatitis C is the most common chronic liver disease and accounts for 8,000 to 13,000 deaths each year. The majority of liver transplants

performed in the United States are done for people with chronic hepatitis C.This article discusses the symptoms, causes, and long term management of hepatitis C virus (HCV). Articles about hepatitis A and B are available separately See "Patient information: Hepatitis A" and "Patient information: Hepatitis B".)HEPATITIS C SYMPTOMSWhen you are first exposed to the hepatitis C virus and become infected, you are said to have "acute hepatitis C". Most people have no symptoms of infection during this time.In 70 to 80 percent of people, the infection becomes chronic. The word "chronic" implies that the infection

will be prolonged, or even lifelong, unless you get treatment that cures the infection.Many people with chronic hepatitis C have no symptoms, even if there is serious liver damage. Of those who do develop symptoms, the most common symptom is fatigue; other less common symptoms include nausea, lack of appetite, muscle or joint aches, weakness, and weight loss.

Also See; SYMPTOMS

HOW DID I BECOME INFECTED WITH HEPATITIS C?The hepatitis C virus is spread by contact with blood.Blood and blood products — Hepatitis C was commonly spread by contaminated blood transfusions until the early 1990s, when a blood test was developed to screen blood donors for hepatitis C. As a result, the current risk of becoming infected with hepatitis C from a blood transfusion is quite small, estimated at one in 1.9 million.(See "Patient information: Blood donation and transfusion".)Sex — The hepatitis C virus can be spread through sex, although the risk is much smaller than with other types of viruses. The risk of transmission between stable monogamous sexual partners (ie, between sexual partners who have no

other sexual contacts) is estimated to be approximately one in a thousand per year. Because of this small risk, most experts do not feel that use of condoms is necessary to prevent transmission of hepatitis C in monogamous couples.However, if you do NOT have a stable monogamous sexual partner, you SHOULD use condoms. This is to protect you from new infections (such as HIV or other sexually transmitted diseases) as well as to protect your partner from acquiring hepatitis C.The risk of transmitting the virus is higher in people who are infected with both hepatitis C and HIV. Condoms are recommended during sex for all people who have HIV.

Video/ HCV and Sex

Other transmission — There is no evidence that kissing, hugging, sneezing, coughing, casual contact, sharing food, water, eating utensils or drinking glasses, or having other contact without blood exposure can spread the hepatitis C virus.However, sharing toothbrushes, razors, and other objects that might be contaminated with blood is NOT recommended. This also applies to implements (such as straws) used to inhale cocaine and needles and syringes used to inject drugs.Pregnancy — The risk of transmitting hepatitis C to your baby during pregnancy probably depends on the level of virus in your blood stream. In general, the risk is about 5 to 6 percent (about 1 in 20) but is increased in people who are also infected with HIV, in whom the risk increases to 12 percent or 1 in 8.Women with hepatitis C who are pregnant or thinking about pregnancy should speak to their doctor about these risks.

Also See; TRANSMISSIONSEXUAL TRANSMISSIONSee "Perinatal transmission of hepatitis C virus" and "Pregnancy in women with underlying chronic liver disease".)HEPATITIS C DIAGNOSISBlood tests — Hepatitis C is diagnosed with a blood test. In most cases, a screening blood test (hepatitis C virus antibody) is done because you have one

or more risk factors for the infection, including the following:Recent exposure to blood infected with HCV (eg, an accidental needle stick)Being HIV positivePast or current sexual partner of a person with HCVPrevious or current use of IV drugsPrevious or current use of hemodialysis for kidney failureRecipient of donated blood or organs before July 1992 or blood clotting factors before 1987Less commonly, a screening test will be done because you have symptoms of recent hepatitis infection, such as a lack of appetite, nausea, flu-like symptoms, or pain under the ribs on the right side (where the liver is located).If the screening test is positive for hepatitis C, further testing is performed to confirm that the virus is present. Results of these tests are used to guide treatment:Hepatitis C virus (HCV) RNA is a measure of the amount of virus circulating in the blood. HCV RNA is detectable in the

blood within days to eight weeks following exposure.Hepatitis C genotype testing determines the specific type of HCV; most people in the United States have type I.Liver biopsy — A liver biopsy is not required to diagnose hepatitis C. However, a liver biopsy is often performed if your doctor is planning to start hepatitis C treatment. Results of the biopsy can help to determine the stage of the disease and the long-term prognosis.Liver biopsy is done as a day surgery procedure, and involves taking a tiny sample of the liver tissue and looking at it under a microscope. The procedure is described in detail in a separate article.Also See;ALTERNATIVE TO BIOPSYSTILL NEED A BIOPSY ?ON BIOPSY WHAT DOES THE STAGE MEAN AND WHAT DOES THE GRADE ME ?(See "Patient information: Liver biopsy".)

HEPATITIS C COMPLICATIONSThe hepatitis C virus causes damage to the liver, although the liver is able to repair itself to some degree. This damage occurs over many years.In some people, scar tissue (called fibrosis) accumulates in the liver, which can eventually become extensive, leading to cirrhosis. People with cirrhosis have a severely scarred liver and are at increased risk for serious complications.Also See;

Disease progression of hepatitis C STAGES/LIVER DISEASE

What is Fibrosis In Hepatitis CSection 1: Liver Disease ProgressionCIRRHOSIS(See "Patient information: Cirrhosis".)EXTRAHEPATIC CONDITIONSTreating compensated and decompensated cirrhosis in HCV One of the most feared complications of cirrhosis is the development of liver cancer (called hepatocellular carcinoma). About 2 percent of people with cirrhosis (1 in 50) develop hepatocellular carcinoma each year. Therefore, the majority of people with cirrhosis due to hepatitis C will not develop hepatocellular carcinoma.Risk factors for complications — Researchers have studied large groups of people with hepatitis C to find out what happens to them over time. Only about 20 percent (or one in five) will develop cirrhosis within 20 years of

becoming infected with hepatitis C. Most others will have some inflammation in the liver, but will not have significant scarring.Researchers have tried to identify factors that increase the risk of developing cirrhosis after becoming infected with hepatitis C. The most important include:Drinking alcohol — People with hepatitis C who drink alcohol are at a much greater risk for developing cirrhosis. The amount of alcohol that is safe to consume is not well established for people with hepatitis C. Even small amounts (social drinking) have been linked to an increased risk of cirrhosis in people with hepatitis C. Until more is known, we recommend completely avoiding alcohol.Amount of liver damage — Increasing amounts of inflammation in the liver make it more likely that the liver will become scarred. There are many tools for determining how much damage hepatitis C has caused, including blood tests, an ultrasound of the liver, and

liver biopsy. Liver biopsy is the "gold standard" test, although it is not recommended in everyoneHEPATITIS C TREATMENT OPTIONSThe goal of hepatitis C treatment is to prevent worsening of liver disease.NEWLY DIAGNOSEDPEGASYS/ PEGINTRON

HCV Treatment in People with Fibrosis & CirrhosisInternet Conferences/Updates on HCV Experimental TherapiesNew Drugs In DevolvementHCV TRIALS

Telaprevir or BoceprevirFAQ English (PDF) 881 KB FAQ English (Word) 1.9 MBFAQ English (html) 3.6 MB

Age in HCVSee "Treatment of chronic hepatitis C virus infection: Recommendations for adults"1st Update - "Hepatitis C Treatment: Should I Wait, or Do It Now?"Pegylated interferon and ribavirin — The most common treatment for hepatitis C is a combination of two medicines, pegylated interferon and ribavirin. The ribavirin treatment is taken as a pill, and the pegylated interferon is taken as a weekly shot. The recommended duration of treatment with this combination is 48 weeks for genotype 1, and usually 24 weeks for genotype 2 and 3.During treatment, you will have tests to

monitor the level of the virus in your blood (called the viral load). The goal of treatment is to completely get rid of the virus. Treatment may be stopped early if the virus does not respond or if you have intolerable treatment-related side effects.Side effects occur in almost 80 percent of patients who are given pegylated interferon and ribavirin. The most common side effects include flu-like symptoms, low levels of red and white blood cells, and fatigue. Treatments to minimize these symptoms are available.Should I be treated? — The decision to have treatment for chronic hepatitis C infection is based upon a number of factors, some of which are discussed below. Treatment for hepatitis C is not recommended for everyone; you and your doctor should discuss the potential risks and benefits of treatment before you begin.Treatment with interferon is not recommended for people whose depression is not well controlled. People with

uncontrolled depression are at risk for committing suicide during treatment. Interferon can be used in people with well-controlled depression.Ribavirin is not recommended in women who are pregnant, thinking about pregnancy or unable to use a reliable form of birth control.People with underlying autoimmune disorders (eg, lupus, rheumatoid arthritis) might have an increased risk of treatment-related complications related to interferon.Certain groups of people develop liver scarring at a slow rate. In this group, it is reasonable to delay treatment until fibrosis progresses, liver function testing becomes abnormal, or clinical trials prove that earlier treatment is of benefit. This group includes people who:- Have normal liver function tests (ALT)- Were infected with hepatitis C before age 35 years- Are female- Do not drink alcohol- Have no or minimal scarring on liver biopsyCure — The chance of being cured

of hepatitis C depends in part on the type of hepatitis C virus (ie, the genotype). Overall, the chance is approximately 40 to 50 percent for people with genotype 1 and 80 percent or more with genotypes 2 and 3.To determine if you are cured, you must wait six months after finishing treatment. Cure is defined as having a viral load of zero for more than six months after stopping treatment. Follow-up studies of these people have shown no trace of the virus in the blood or liver for over 10 years. However, the virus comes back after treatment in about 25 to 30 percent of cases.If hepatitis C does not respond or comes back — There are several options for people who's virus do not respond or whose infection comes back after the first round of treatment. The best option depends upon what medicines you took before, how well you tolerated the previous treatment, your current liver function, and other factors.Options include watching

and waiting, trying a different treatment regimen, or enrolling in a clinical trial (see 'Clinical trials' below). Discuss your options with a doctor who specializes in liver diseases (a hepatologist) or infectious diseases.LONG-TERM MANAGEMENT OF HEPATITIS CScreening tests — If you have hepatitis C and cirrhosis, you should have a screening tests for hepatocellular carcinoma, which usually includes an ultrasound of the liver plus a blood test (alpha fetoprotein level) every year or every other year.In addition, a procedure called an upper endoscopy might be done to look for esophageal varices (enlarged veins in the esophagus). Varices develop in roughly 50 percent of people with cirrhosis. Upper endoscopy uses a thin, flexible fiberoptic instrument to inspect the esophagus (food pipe) and stomach

Liver Cancer and HCV-infected individuals who do not have cirrhosis

FIRST RELIABLE TEST FOR LIVER CANCER

Liver Cancer in HCV /Video(See "Patient information: Screening for esophageal varices".)Diet — No specific diet improves signs or symptoms of hepatitis C. The best advice is to eat a normal, healthy, and balanced diet. It is reasonable to take a multivitamin without iron. It is safe to drink coffee; in fact some studies suggest that coffee is good for the liver. Drinking alcohol is strongly discouraged to protect the liver from further damage.

VIDEO: Diet Influences Liver Disease Risk

Eating To Help Fight Fatigue

Smoking Affect Hepatitis C Progression?Don't Fatten Your Liver

Vaccines Anyone who is infected with hepatitis C should be vaccinated against hepatitis A and B, unless you are already immune. A blood test can tell if you are immune.A vaccine that helps to prevent pneumonia is recommended.

A vaccine that helps to prevent pneumonia is recommended. (See "Patient information: Pneumonia prevention".)Influenza (flu) vaccination is recommended every year, usually in the fall. (See "Patient information: Influenza prevention".)Routine vaccines are also recommended, including diphtheria and tetanus booster every ten years. Read more about adult vaccines separately. (See "Patient information: Adult vaccines" and "Immunizations for patients with chronic liver disease".)

Exercise — Exercise is good for overall health and is encouraged, but it has no effect on hepatitis C virus.

Prescription and nonprescription medicines — The liver breaks down many medicines, including prescription and non-prescription medicines, supplements, and herbs. Thus, it is always best to check with your doctor or pharmacist before starting a new medicine. Most medicines are safe for people with hepatitis C unless the liver is scarred.One important exception is acetaminophen (Tylenol®); the maximum recommended dose is no more than 2000 milligrams or 2 grams per 24 hours or 500 mg every 6 hours (four times per day).

You should completely avoid ibuprofen (sold as Advil, Motrin, and store brands), naproxen (sold as Aleve and store brands), and aspirin (sold as Bufferin, Excedrin, and store brands).Daily use of marijuana has been associated with worsening liver disease and is not recommended, particularly for people with hepatitis C.

Taking Low Dose Aspirin and NSAIDs? Know Your Risk.

Reminder/Acetaminophen and Liver Damage

Herbal medicines — Many herbal products claim to "cure" or improve hepatitis C; none of these claims has been proven true. In addition, some herbal medicines can seriously injure the liver.Support — Sharing your concerns with others who have the same diagnosis can help you learn to live with hepatitis C. The American Liver Foundation has helpful advice and list of support groups (http://www.liverfoundation.org/).

Milk Thistle for the Liver -- Any Evidence?

If you have recently discovered that you or someone you care about has hepatitis C, there are many reasons to be optimistic:Hepatitis C progresses slowly, and many people who are infected will never get sick.You are not alone; about 2.7 million people in the United States have hepatitis C. Treatment is available and researchers are constantly working to develop new and better therapies.

CLINICAL TRIALSEven though combination therapy with interferon plus ribavirin cures about 50 percent of people with hepatitis C (up to 80 percent with genotype 2 and 3), many are not cured. Thus, new treatments for hepatitis C are actively being developed.A clinical trial is a carefully controlled way to study how well new treatments or new combinations of known therapies work. Ask for more information about clinical trials or read about clinical trials at http://clinicaltrials.gov/

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